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Risk factors for type 2 diabetes mellitus: An exposure-wide umbrella review of meta-analyses
Open accessAbstract
BACKGROUND: Type 2 diabetes mellitus (T2DM) is a global epidemic associated with increased health expenditure, and low quality of life. Many non-genetic risk factors have been suggested, but their overall epidemiological credibility has not been assessed. METHODS: We searched PubMed to capture all meta-analyses and Mendelian randomization studies for risk factors of T2DM. For each association, we estimated the summary effect size, its 95% confidence and prediction interval, and the I2 metric. We examined the presence of small-study effects and excess significance bias. We assessed the epidemiological credibility through a set of predefined criteria. RESULTS: We captured 86 eligible papers (142 associations) covering a wide range of biomarkers, medical conditions, and dietary, lifestyle, environmental and psychosocial factors. Adiposity, low hip circumference, serum biomarkers (increased level of alanine aminotransferase, gamma-glutamyl transferase, uric acid and C-reactive protein, and decreased level of adiponectin and vitamin D), an unhealthy dietary pattern (increased consumption of processed meat and sugar-sweetened beverages, decreased intake of whole grains, coffee and heme iron, and low adherence to a healthy dietary pattern), low level of education and conscientiousness, decreased physical activity, high sedentary time and duration of television watching, low alcohol drinking, smoking, air pollution, and some medical conditions (high systolic blood pressure, late menarche age, gestational diabetes, metabolic syndrome, preterm birth) presented robust evidence for increased risk of T2DM. CONCLUSIONS: A healthy lifestyle pattern could lead to decreased risk for T2DM. Future randomized clinical trials should focus on identifying efficient strategies to modify harmful daily habits and predisposing dietary patterns.
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In the citing paper
“Clinical guidelines recommend the monitoring of HbA1c every three months with frequent therapy modification until the glycemic goal is achieved [5].”
From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [5]
Experimental — accuracy not yet measuredIn the citing paper
“Obesity was associated with an increased risk of AD, DM, CHD, stroke and liver and bowel cancer by between 33% and 588%.11,77,81,85”
From Common risk factors for major noncommunicable disease, a systematic overview of reviews and commentary: the implied potential for targeted risk reduction (2019) · cites this paper as [77]
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“High adherence to a Mediterranean diet was shown to reduce risk across all five NCDs by between 4% and 36%,11,77,90,93,98”
From Common risk factors for major noncommunicable disease, a systematic overview of reviews and commentary: the implied potential for targeted risk reduction (2019) · cites this paper as [77]
In the citing paper
“higher levels of physical activity similarly resulted in risk reduction of between 13% and 45%.11,75,77,94”
From Common risk factors for major noncommunicable disease, a systematic overview of reviews and commentary: the implied potential for targeted risk reduction (2019) · cites this paper as [77]
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Metadata
- Authors
- Bellou, V., Belbasis, L., Tzoulaki, I., & Evangelou, E.
- Affiliations
- University of Ioannina (GR)
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2018-03-20
- Volume
- 13
- Issue
- 3
- Pages
- e0194127
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC5860745
- OpenAlex
- W2789317488
- Cited by
- 713
- References
- 136
- Citations by year
- 2026: 58 · 2025: 72 · 2024: 116 · 2023: 115 · 2022: 117 · 2021: 97 · 2020: 82 · 2019: 46 · 2018: 10
- FWCI
- 9.04
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Spiral (Imperial College London) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adipokines, Inflammation, and Metabolic Diseases
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic Associations and Epidemiology
- Keywords
- type 2 diabetes, risk factors, non-genetic risk factors, adiposity, serum biomarkers, dietary habits, physical activity, sedentary behavior, alcohol consumption, smoking, air pollution, metabolic syndrome, gestational diabetes mellitus, preterm birth, educational attainment, conscientiousness, psychosocial factors, umbrella review of meta-analyses, Mendelian randomization
- MeSH terms
- Air Pollution, Diabetes Mellitus, Type 2, Diet, Humans, Life Style, Obesity, Risk Factors, Exercise
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